Estado actual de la hepatitis aguda C | Enfermedades Infecciosas y Microbiología Clínica

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Se conoce bien su prevalencia, pero resulta difícil evaluar la tasa real de nuevos casos. El hecho de que la fase aguda de la infección por el VHC muchas veces pase desapercibida, por presentarse de forma asintomática o paucisintomática, unido a que no existe un marcador serológico específico para el diagnóstico de la hepatitis aguda, justifica el que no se conozca con certeza la incidencia de hepatitis aguda C (HAC).En esta revisión, tratamos de sintetizar la información existente sobre la HAC: describir su historia natural, la epidemiología de la infección y discutir las recomendaciones de tratamiento.EpidemiologíaSegún la Organización Mundial de la Salud (OMS), el 2,5% de la población mundial está infectada por VHC. Los diferentes estudios epidemiológicos realizados en España muestran que la prevalencia es parecida y varía entre el 1 y el 2,6%, lo que supone que existen entre 480.000 y 760.000 personas infectadas<a class="elsevierStyleCrossRef" href="#bib0005">1</a>.Las estimaciones de incidencia de infección aguda por el VHC varían ampliamente dependiendo de los métodos de evaluación y la institución que los informa. Ejemplo de ello, son los datos reportados en Italia, donde la incidencia varía desde 1 hasta 14 infecciones por cada 100.000 de acuerdo a la agencia nacional de vigilancia<a class="elsevierStyleCrossRef" href="#bib0010">2</a>, el programa de donante de sangre italiano<a class="elsevierStyleCrossRef" href="#bib0015">3</a> o la evaluación en la población general<a class="elsevierStyleCrossRef" href="#bib0020">4</a>.A pesar de la dificultad existente para conocer la tasa real de nuevos casos de infección por el VHC, se ha señalado una gran disminución de su incidencia en los últimos años. Este descenso se ha conseguido, en gran parte, gracias a las medidas preventivas establecidas: la introducción del test de cribado para el VHC en los bancos de sangre, la extensión entre los drogadictos de los programas de intercambio de jeringuillas y la generalización en el uso de material médico desechable en muchos países.Es necesario un alto índice de sospecha clínica y un seguimiento serológico y virológico estrecho para detectar nuevos casos de HAC<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a>. En un elevado porcentaje de casos, se diagnostica en el contexto de la vigilancia post-exposición y en grupos de riesgo<a class="elsevierStyleCrossRefs" href="#bib0035">7–9</a>.Se repasan a continuación las diferentes vías de trasmisión del VHC.La transmisión por vía parenteral, y en particular el consumo de drogas endovenosas, ha representado la principal causa de contagio para el VHC en los países desarrollados<a class="elsevierStyleCrossRef" href="#bib0050">10</a>. Recientemente, sin embargo, se ha descrito un creciente número de HAC en varones homosexuales infectados por el virus de la inmunodeficiencia humana (VIH), lo que sugiere que la epidemiología de la transmisión del VHC está cambiando<a class="elsevierStyleCrossRefs" href="#bib0045">9,11–16</a>.La transmisión por transfusión de sangre casi ha desaparecido en los países desarrollados tras la instauración del despistaje en los bancos de sangre con la aplicación de la PCR (reacción en cadena de la polimerasa) automática para el ARN (ácido ribonucleico) de VHC en los donantes<a class="elsevierStyleCrossRef" href="#bib0080">16</a>.La transmisión por el consumo de drogas sigue siendo el modo predominante (38%) de infección en algunas áreas, sobre todo en los países de Europa oriental<a class="elsevierStyleCrossRef" href="#bib0085">17</a>; pero es prácticamente inexistente en los países occidentales dado el descenso del consumo de drogas por vía endovenosa, la implantación de los programas de intercambio de jeringuillas y de mantenimiento con metadona. En el colectivo de usuarios de drogas por vía endovenosa, debemos tener presente que la reinfección no es infrecuente<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a>.La transmisión nosocomial representa entre el 15-25% de los casos<a class="elsevierStyleCrossRefs" href="#bib0095">19–21</a>. Este modo de contagio habitualmente acontece en forma de pequeña epidemia<a class="elsevierStyleCrossRefs" href="#bib0095">19,22</a> y, en la mayoría de casos, es debida a una falta en el cumplimiento de las normas estándar de higiene<a class="elsevierStyleCrossRef" href="#bib0115">23</a>. Los factores de riesgo relacionados con mayor frecuencia al contagio nosocomial son la cirugía y los procedimientos diagnósticos invasivos<a class="elsevierStyleCrossRefs" href="#bib0095">19–21</a>.La transmisión ocupacional, el contagio por exposición a sangre, representaría entre un 10-20% de los casos de HAC según se muestran en algunas cohortes retrospectivas<a class="elsevierStyleCrossRefs" href="#bib0120">24,25</a>. Los resultados de estudios recientemente publicados muestran un menor riesgo de transmisión tras el pinchazo accidental (0,3-2,8%)<a class="elsevierStyleCrossRef" href="#bib0130">26</a>.La transmisión vertical es poco eficaz y representa el 5% de los casos<a class="elsevierStyleCrossRef" href="#bib0135">27</a>. La infección no se transmite por lactancia materna<a class="elsevierStyleCrossRef" href="#bib0140">28</a>. La hepatitis C vertical cursa de forma asintomática en la mayoría de casos. El 20% de los niños negativizan el ARN del VHC en los tres primeros años de vida<a class="elsevierStyleCrossRef" href="#bib0145">29</a>.El riesgo de transmisión sexual en parejas serodiscordantes heterosexuales se considera muy bajo, < 1%<a class="elsevierStyleCrossRefs" href="#bib0150">30–32</a>; y por tanto, no se recomiendan métodos de barrera preventivos en estos casos. En los pacientes coinfectados por el VIH, parece que el riego de transmisión sexual es mayor<a class="elsevierStyleCrossRef" href="#bib0165">33</a>. En los últimos 10 años, un creciente número de casos de HAC se han notificado en grandes centros urbanos en Europa<a class="elsevierStyleCrossRefs" href="#bib0045">9,11,12</a>, los Estados Unidos<a class="elsevierStyleCrossRefs" href="#bib0065">13,14,34</a> y Australia<a class="elsevierStyleCrossRef" href="#bib0075">15</a>. Estudios de cohortes longitudinales han confirmado un aumento en la incidencia del VHC entre pacientes homosexuales VIH-positivos en Inglaterra<a class="elsevierStyleCrossRef" href="#bib0175">35</a> y los Países Bajos<a class="elsevierStyleCrossRef" href="#bib0180">36</a>. Un estudio internacional reciente ha demostrado, tras realizar un análisis filogenético, un alto grado de relación de las muestras del VHC de diferentes países, lo que sugiere una propagación de la hepatitis C a través de una red sexual internacional<a class="elsevierStyleCrossRef" href="#bib0185">37</a>.El aumento de la incidencia de HAC en el colectivo homosexual VIH seropositivo se ha atribuido a diferentes factores: una mayor carga viral del VHC en los pacientes coinfectados por el VIH a nivel de sangre y semen<a class="elsevierStyleCrossRefs" href="#bib0190">38–40</a>, determinadas prácticas sexuales en las que existe un riesgo mayor de daño de la mucosa, la presencia de otras ETS ulcerativas como el linfogranuloma venéreo o la sífilis de forma concomitante<a class="elsevierStyleCrossRef" href="#bib0205">41</a>, un mayor número de parejas sexuales<a class="elsevierStyleCrossRef" href="#bib0210">42</a> y el uso de drogas recreativas como la gamma hidroxibutirato (GHB)<a class="elsevierStyleCrossRef" href="#bib0185">37</a>.Se ha propuesto que la coinfección por el VIH podría facilitar la transmisión del VHC. Por un lado, aumentaría la infectividad viral al presentarse con una mayor carga viral del VHC en el suero y semen y por otro lado, estaría incrementada la susceptibilidad viral debido a un control inmunológico deficiente del VHC<a class="elsevierStyleCrossRefs" href="#bib0215">43,44</a>. No obstante, existen datos contradictorios en este campo, ya que es frecuente el diagnóstico de la infección aguda por el VHC en pacientes con recuentos de CD4 relativamente preservados o bien realizar un diagnóstico concomitante de primoinfección VIH y de HAC. Parece pues que las conductas sexuales tendrían un papel más importante que el propio VIH como factor de riesgo en la presentación de HAC en estos pacientes<a class="elsevierStyleCrossRef" href="#bib0225">45</a>.ClínicaLa hepatitis aguda ocurre después de un período de incubación variable de 15 a 160 días (media de 7 semanas).Sólo el 20-30% de todos los pacientes que contrae una hepatitis aguda por el VHC presentarán clínica. Los síntomas prodrómicos son sistémicos y variables. La aparición de la ictericia puede estar precedida por 1 o 2 semanas de anorexia, náuseas y vómitos, astenia, artralgias, mialgias, dolor de cabeza, fotofobia y faringitis, así como alteraciones del gusto y olfato. Se puede apreciar coluria e hipocolia de uno a cinco días antes de la aparición de la ictericia clínica. El hígado aumenta de tamaño y puede haber dolor en hipocondrio derecho. Un 10-20% de los pacientes tienen esplenomegalia y adenopatías cervicales.La fase de recuperación, fase post-ictérica, se prolonga de 2 a 12 semanas.La presentación clínica de la HAC en el paciente VIH seropositivo es muy similar a la de la población monoinfectada. Algunos autores sugieren que podría manifestarse con menos signos o síntomas clínicos de hepatitis y con elevaciones más discretas de la ALT sérica en comparación con los pacientes no infectados por el VIH<a class="elsevierStyleCrossRef" href="#bib0230">46</a>.EvoluciónLa HAC evoluciona a infección crónica hasta en el 85% de los casos.La eliminación espontánea se produce en el 23-44% de los pacientes, según el estudio analizado<a class="elsevierStyleCrossRefs" href="#bib0235">47,48–51</a>, y suele ocurrir dentro de las 12 semanas después del diagnóstico; no obstante, se han descrito casos aislados de seroconversión tardía, hasta 12 meses<a class="elsevierStyleCrossRefs" href="#bib0240">48,51</a>.En general, los pacientes con enfermedad sintomática, ictericia o síntomas pseudogripales, parecen experimentar una mayor eliminación viral espontánea<a class="elsevierStyleCrossRefs" href="#bib0235">47–50,52</a>. También se ha observado un porcentaje muy elevado de curación espontánea en los pacientes que presentan una disminución rápida de la carga viral<a class="elsevierStyleCrossRefs" href="#bib0265">53,54</a>.Varios trabajos han demostrado que una respuesta inmune celular fuerte y multiespecífica sería un factor importante para la erradicación viral espontánea<a class="elsevierStyleCrossRefs" href="#bib0275">55–57</a>.Existe en la actualidad gran interés en los estudios genéticos; se ha descrito que la presencia de un polimorfismo en el gen que codifica para la interleukina (IL28B) en el cromosoma 19 predice la eliminación viral espontánea<a class="elsevierStyleCrossRef" href="#bib0290">58</a>, así como un mayor porcentaje de respuesta viral al tratamiento anti-VHC en el paciente monoinfectado<a class="elsevierStyleCrossRef" href="#bib0295">59</a>. En el paciente coinfectado por el VIH, este polimorfismo también se ha relacionado con la RVS al tratamiento<a class="elsevierStyleCrossRefs" href="#bib0300">60,61</a>, pero no con una mayor eliminación viral espontánea en la HAC<a class="elsevierStyleCrossRef" href="#bib0305">61</a>.Estudios recientes sobre el diagnóstico y el curso natural de la infección aguda por el VHC en personas VIH-positivas han reportado porcentajes de eliminación espontánea de entre 13 y 16%<a class="elsevierStyleCrossRefs" href="#bib0310">62,63</a>, valores menores en comparación con los individuos mono-infectados. Desafortunadamente no existen datos sobre el tiempo necesario de espera para valorar la eliminación viral espontánea en el paciente coinfectado.Debemos tener en cuenta que los pacientes VIH con HAC, tienen mayor riesgo de progresión de la enfermedad hepática relacionada<a class="elsevierStyleCrossRef" href="#bib0320">64</a> y menor respuesta a la terapia antiviral para el VHC.DiagnósticoDatos de laboratorioLa elevación de aminotransferasas se inicia en la fase prodrómica de la hepatitis antes del aumento de bilirrubina.Se puede observar de forma transitoria, neutropenia y linfopenia, seguidas de linfocitosis relativa. Son frecuentes los linfocitos atípicos durante la fase aguda. También durante esta fase, se pueden detectar anticuerpos anti músculo liso, antinucleares y otros componentes celulares, factor reumatoide y anticuerpos heterófilos a título bajo. Es común una ligera elevación de gammaglobulinas.El diagnóstico de la infección aguda por el VHC se basa en la detección de ARN del VHC por PCR junto a documentación de la existencia de una seroconversión de los anticuerpos del VHC (anti VHC). En aquellos casos que la seroconversión anti VHC no se puede probar, existen unos criterios adicionales que pueden apoyar el diagnóstico de sospecha: los niveles de ALT > 10-20 veces el límite superior de lo normal, la sospecha de un contacto de riesgo con el VHC los 6 meses previo y haberse descartado cualquier otra causa de daño hepático (<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>El screening serológico de anti VHC no es fiable durante la infección temprana, ya que estos anticuerpos pueden tardar hasta 12 semanas tras la exposición en detectarse. Asimismo pueden existir falsos anti VHC positivos en pacientes con factor reumatoide. En estos casos, es posible realizar un ensayo de inmunoblot recombinante (RIBA) de confirmación, para establecer las proteínas específicas a las que se dirige el anti VHC.La determinación de ARN de VHC por PCR es el método más sensible para el diagnóstico de infección por VHC y aparece antes de los anti VHC y de la elevación de transaminasas; hasta en un 30% de los pacientes el análisis de ARN del VHC por PCR será la única posibilidad de diagnosticar la infección aguda por el VHC<a class="elsevierStyleCrossRef" href="#bib0325">65</a> (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>TratamientoNo es necesario el reposo en cama para la recuperación, pero algunos pacientes con astenia importante se encuentran mejor restringiendo su actividad física. Es aconsejable una dieta elevada en calorías y no muy grasa para evitar la sensación de plenitud.El ingreso para administración de líquidos intravenosos puede estar indicado si existe un cuadro de vómitos importante. Se debe evitar medicación metabolizada en el hígado y hepatotóxica. Si es muy llamativo el prurito, se puede utilizar resincolestiramina.A diferencia de la hepatitis C crónica, no ha sido establecida hasta el momento cual debe ser la pauta de terapia antiviral estándar en la fase aguda de la enfermedad y muchos aspectos importantes del tratamiento están actualmente bajo investigación. Los ensayos clínicos centrados en el tratamiento de la HAC se ven obstaculizados por las dificultades en su diagnóstico. Así, la mayoría de los estudios que existen son abiertos, no comparativos e incluyen pocos pacientes. Cómo difieren ampliamente entre ellos en cuanto a diseño, población de pacientes y los regímenes de tratamiento, no es posible discernir de forma rotunda cual es la intervención más eficaz.Los datos obtenidos hasta la fecha en diferentes estudios realizados en pacientes monoinfectados muestran que tanto el interferón convencional como el pegilado son útiles en el tratamiento de la HAC y que la terapia combinada con ribavirina no mejora los resultados<a class="elsevierStyleCrossRefs" href="#bib0260">52,61,66-69</a>. Además se ha valorado que el porcentaje de respuesta viral sostenida (RVS) a la terapia en la HAC es independiente del genotipo del VHC. En cuanto a la duración óptima del tratamiento se establece en 24 semanas. Pequeños estudios con pocos pacientes han analizado la posibilidad de reducir el tratamiento a 12 semanas pero, hasta el momento, los resultados obtenidos son insuficientes para poder establecer una guía<a class="elsevierStyleCrossRefs" href="#bib0335">67,70</a>.El tratamiento se debe iniciar entre la 8a y 12a semanas tras el diagnóstico, si no se ha resuelto espontáneamente la infección. Empezar el tratamiento inmediatamente tras el diagnóstico del paciente, puede significar que algunos pacientes que podrían aclarar de forma espontánea el virus sean expuestos a la terapia antiviral sin necesidad de ella; pero retrasarlo disminuiría su eficacia. La terapia generalmente es bien tolerada y se alcanza una RVS del 71-98% en los ensayos en pacientes monoinfectados tratados durante 24 semanas (<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>La mayoría de los datos disponibles de respuesta al tratamiento de la HAC en individuos infectados por el VIH son estudios realizados con pautas de 24 semanas de duración con terapia combinada con interferón pegilado más ribavirina. Estos estudios muestran un porcentaje muy variable de RVS del 0-80%<a class="elsevierStyleCrossRefs" href="#bib0060">12,13,15,33,71–76</a> (<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>), y menor a la observada en los individuos monoinfectados con HAC. Teniendo en cuenta el curso clínico de la HAC, la European AIDS Clinical Society (EACS)<a class="elsevierStyleCrossRef" href="#bib0385">77</a> recomienda la intervención terapéutica temprana a partir de la semana 12 y evitar cualquier demora de tratamiento posterior que podría dar lugar a una disminución de la respuesta al tratamiento.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>La discusión actual de la individualización del tratamiento en la hepatitis crónica C también influye en el debate de la HAC. Se han descrito varios factores predictivos de RVS en la literatura: la ictericia<a class="elsevierStyleCrossRefs" href="#bib0165">33,48</a>, la importancia de la respuesta inmunológica<a class="elsevierStyleCrossRef" href="#bib0390">78</a>, la transmisión nosocomial, una carga viral baja, la edad menor de 30 años y la rápida reducción de la carga viral en las primera semanas<a class="elsevierStyleCrossRefs" href="#bib0075">15,49,50,72</a>. En el paciente coinfectado, el presentar niveles altos basales de ALT así como un recuento elevado de CD471 y la negativización de ARN del VHC de forma precoz<a class="elsevierStyleCrossRefs" href="#bib0075">15,72</a> son los factores que se ha relacionado con la RVS.ProfilaxisLa respuesta inmunitaria humoral que se produce ante el VHC no es efectiva. Los anticuerpos anti VHC no son bloqueantes del virus; de esta forma, el contagio por el VHC no produce inmunidad permanente frente a la reinfección por el mismo u otro genotipo de VHC. Así se han descrito casos de superinfección y reinfección por el VHC<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a>.El desarrollo de vacunas está limitado por la heterogeneidad del virus (genotipos, cuasiespecies) y la fácil evasión del virus a anticuerpos neutralizantes por su rapidez para mutar.Es necesario destinar recursos para promover campañas educativas dirigidas a pacientes y médicos, insistir en la prevención específica en los grupos de riesgo, mejorar la detección y facilitar el tratamiento del VHC. La detección de anti VHC debe ser parte de la atención habitual de todos los pacientes homosexuales VIH y debemos tener un alto grado de alerta clínico ante la posibilidad de una infección concomitante por VHC para cualquier paciente que se presente con una enfermedad de transmisión sexual o que informe de haber presentado una exposición de alto riesgo.Conflicto de interesesLos autores declaran no tener ningún conflicto de intereses." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres150531" "titulo" => "Resumen" ] 1 => array:2 [ "identificador" => "xpalclavsec138472" "titulo" => "Palabras clave" ] 2 => array:2 [ "identificador" => "xres150530" "titulo" => "Abstract" ] 3 => array:2 [ "identificador" => "xpalclavsec138473" "titulo" => "Keywords" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introducción" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Epidemiología" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Clínica" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Evolución" ] ] ] 7 => array:3 [ "identificador" => "sec0025" "titulo" => "Diagnóstico" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Datos de laboratorio" ] ] ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Tratamiento" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Profilaxis" ] 10 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicto de intereses" ] 11 => array:1 [ "titulo" => "Bibliografía" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-08-04" "fechaAceptado" => "2010-12-16" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec138472" "palabras" => array:4 [ 0 => "Hepatitis aguda C" 1 => "Epidemiología" 2 => "Clínica" 3 => "Diagnóstico y tratamiento" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec138473" "palabras" => array:4 [ 0 => "Acute hepatitis C" 1 => "Epidemiology" 2 => "Clinical features" 3 => "Diagnosis and treatment" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La hepatitis aguda C (HAC) representa un problema sanitario en auge. A pesar del descenso de la transmisión del VHC por vía hematológica gracias a los programas de detección de donantes y el menor consumo de drogas por vía intravenosa, actualmente existe un aumento de su incidencia debido al contagio por vía sexual, sobretodo en pacientes homosexuales infectados por el VIH. La presentación de forma paucisintomática es frecuente, lo cual dificulta su diagnóstico. La eliminación espontánea del virus ocurre en el 25% de los casos y, habitualmente, durante los primeros tres meses tras el inicio de la clínica y en pacientes sintomáticos. Si el ARN del VHC persiste detectable pasado este tiempo debe iniciarse sin demora tratamiento antiviral, ya que en la fase aguda el porcentaje de respuesta viral sostenida es mayor al que se obtiene después en la hepatopatía crónica. La pauta de tratamiento óptima (interferón sólo o asociado a ribavirina), así como la duración de la misma no están claramente establecidas en el momento actual." ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Acute hepatitis C (AHC) is an increasing health issue. Despite the decline of blood-to-blood transmission of hepatitis C virus (HCV) through donor screening programs and a decline in intravenous drug use, the incidence of sexual transmission has now increased, particularly in HIV-infected homosexual patients. The presentation is almost always asymptomatic, which complicates diagnosis. Spontaneous clearance of the virus occurs in 25% of cases and usually, within the first three months after onset of symptoms and in symptomatic patients. If serum HCV-RNA remains detectable after this period, antiviral treatment should be started without delay, since sustained viral response rate in the acute phase is higher than that achieved with chronic liver disease. The optimal treatment regimen (interferon alone or combined with ribavirin) and its duration are not clearly established at the present time." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 972 "Ancho" => 1583 "Tamanyo" => 102478 ] ] "descripcion" => array:1 [ "es" => "Evolución clínica y analítica de la infección por el VHC." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Tabla 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "ALT: alaninaminotransferasa; ARN del VHC: ácido ribonucleico del virus de la hepatitis C; antiVHC: anticuerpos contra el VHC." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Criterios mayores</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Detección de ARN del VHC en suero en un paciente con un VHC negativo previamente. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Seroconversión de antiVHC negativo a antiVHC positivo. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Criterios secundarios</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Niveles de ALT > 10-20 veces el límite superior de lo normal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sospecha de un contacto de riesgo con el VHC los 6 meses previos. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Se haya descartado cualquier otra causa de daño hepático. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consideraciones adicionales</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aparición repentina de enfermedad hepática. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Repetición de pruebas RIBA (ensayo de inmunoblot recombinante) que demuestren un aumento en el número de proteínas reactivas. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab244537.png" ] ] ] ] "descripcion" => array:1 [ "es" => "Criterios propuestos para el diagnóstico de hepatitis aguda C." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Tabla 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "ADVP: adicción a drogas por vía parenteral; INF alfa: interferón alfa; pac: pacientes; PEG INF: interferón pegilado; RBV: ribavirina; sem: semanas; RVS: respuesta viral sostenida." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Estudio Origen, (cita) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pacientes tratados (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Datos demográficos y clínicos \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Tratamiento \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">RVS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Eliminación espontánea \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alemania<a class="elsevierStyleCrossRef" href="#bib0395">79</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20% ADVP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Interferón \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61% genotipo 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alemania,<a class="elsevierStyleCrossRef" href="#bib0240">48</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27% ADVP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">INF alfa (n=10 pac)+RBV (n=10 pac) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52%</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15% asintomático \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF (n=2 pac)+RBV (n=4 pac) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14-61 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Japón<a class="elsevierStyleCrossRef" href="#bib0400">80</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10% ADVP</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">INF alfa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% inicio 8 sem \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12%</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inicio a 8 vs 52 sem \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53% inicio 52 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inglaterra<a class="elsevierStyleCrossRef" href="#bib0405">81</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46% ADVP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">INF alfa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22% asintomático \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66% genotipo 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alemania<a class="elsevierStyleCrossRef" href="#bib0410">82</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No ADVP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19% asintomático \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67% genotipo 1/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suiza<a class="elsevierStyleCrossRef" href="#bib0415">83</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81% ADVP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19%</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41% asintomático \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Italia<a class="elsevierStyleCrossRef" href="#bib0420">84</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25% ADVP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39%</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25% asintomático \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38% genotipo 1/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Italia<a class="elsevierStyleCrossRef" href="#bib0350">70</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74% asintomático \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58% genotipo 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12sem \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Egipto, Alemania y EE.UU.<a class="elsevierStyleCrossRef" href="#bib0245">49</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">102</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10% ADVP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68% 8 sem \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22%</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87% genotipo 1/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 sem (n=34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82% 12 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 sem (n=34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91% 24 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 sem (n=34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Italia<a class="elsevierStyleCrossRef" href="#bib0425">85</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% ADVP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65% genotipo 1/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Italia<a class="elsevierStyleCrossRef" href="#bib0430">86</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57% ADVP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76% asintomático \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57% genotipo 1/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab244535.png" ] ] ] ] "descripcion" => array:1 [ "es" => "Tratamiento de la hepatitis aguda C en paciente monoinfectado." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Tabla 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "HMX: varón homosexual; INF alfa: interferón alfa; pac: pacientes; PEG INF: interferón pegilado; RBV: ribavirina; sem: semanas; RVS: respuesta viral sostenida." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Estudio origen, (cita) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pacientes tratados (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Datos demográficos y clínicos \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Tratamiento \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">RVS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Eliminación espontánea \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Londres<a class="elsevierStyleCrossRef" href="#bib0355">71</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% HMX \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF+RBV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24%</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86% genotipo 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paris<a class="elsevierStyleCrossRef" href="#bib0395">79</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% HMX \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF+RBV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4%</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72% asintomáticos \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28% genotipo 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">California<a class="elsevierStyleCrossRef" href="#bib0065">13</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75% HMX \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF+RBV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22%</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24-48sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paris<a class="elsevierStyleCrossRef" href="#bib0060">12</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% HMX \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">INF alfa (n=7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83% asintomáticos \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">INF alfa+RBV (n=2) y PEG INF (n=1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83% genotipo 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24-48 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alemania<a class="elsevierStyleCrossRef" href="#bib0365">73</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% HMX \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF (n=15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27%</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91% genotipo 1/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF+RBV (n=21) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24-48 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nueva York<a class="elsevierStyleCrossRef" href="#bib0170">34</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81% HMX \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF+RBV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9%</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91% genotipo 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24-48 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Australia<a class="elsevierStyleCrossRef" href="#bib0075">15</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56% HMX \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF (n=2)+RBV (n=20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73% (16/22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72% asintomáticos \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24sem \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80% (16/20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60% genotipo 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Holanda<a class="elsevierStyleCrossRef" href="#bib0370">74</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% HMX \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF+RBV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64% genotipo 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20% genotipo 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24-48 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA<a class="elsevierStyleCrossRef" href="#bib0375">75</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81% HMX \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF+RBV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24%</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95% genotipo 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alemania<a class="elsevierStyleCrossRef" href="#bib0380">76</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% HMX \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PEG INF (n=2)+RBV (n=51) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77%</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19%</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43% genotipo 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 sem \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35% genotipo 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab244536.png" ] ] ] ] "descripcion" => array:1 [ "es" => "Tratamiento de la hepatitis aguda C en pacientes coinfectados por el VIH." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:86 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C en España" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. 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Estado actual de la hepatitis aguda C

Current status of acute hepatitis C

María Martínez-Rebollar, María Larrousse, Marta Calvo, Ana Muñoz, Ana González, Montse Loncà, Esteban Martínez, José Luis Blanco, Josep Mallolas, Montserrat Laguno

Autor para correspondencia

mlaguno@clinic.ub.es

Autor para correspondencia.

Servicio de Infecciones, Hospital Clinic, Barcelona, España

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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Evoluci&#243;n cl&#237;nica y anal&#237;tica de la infecci&#243;n por el VHC&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El virus de la hepatitis C &#40;VHC&#41; es la principal causa de hepatitis cr&#243;nica en el mundo&#46; Se conoce bien su prevalencia&#44; pero resulta dif&#237;cil evaluar la tasa real de nuevos casos&#46; El hecho de que la fase aguda de la infecci&#243;n por el VHC muchas veces pase desapercibida&#44; por presentarse de forma asintom&#225;tica o paucisintom&#225;tica&#44; unido a que no existe un marcador serol&#243;gico espec&#237;fico para el diagn&#243;stico de la hepatitis aguda&#44; justifica el que no se conozca con certeza la incidencia de hepatitis aguda C &#40;HAC&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En esta revisi&#243;n&#44; tratamos de sintetizar la informaci&#243;n existente sobre la HAC&#58; describir su historia natural&#44; la epidemiolog&#237;a de la infecci&#243;n y discutir las recomendaciones de tratamiento&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Epidemiolog&#237;a</span><p id="par0015" class="elsevierStylePara elsevierViewall">Seg&#250;n la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41;&#44; el 2&#44;5&#37; de la poblaci&#243;n mundial est&#225; infectada por VHC&#46; Los diferentes estudios epidemiol&#243;gicos realizados en Espa&#241;a muestran que la prevalencia es parecida y var&#237;a entre el 1 y el 2&#44;6&#37;&#44; lo que supone que existen entre 480&#46;000 y 760&#46;000 personas infectadas<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Las estimaciones de incidencia de infecci&#243;n aguda por el VHC var&#237;an ampliamente dependiendo de los m&#233;todos de evaluaci&#243;n y la instituci&#243;n que los informa&#46; Ejemplo de ello&#44; son los datos reportados en Italia&#44; donde la incidencia var&#237;a desde 1 hasta 14 infecciones por cada 100&#46;000 de acuerdo a la agencia nacional de vigilancia<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#44; el programa de donante de sangre italiano<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> o la evaluaci&#243;n en la poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A pesar de la dificultad existente para conocer la tasa real de nuevos casos de infecci&#243;n por el VHC&#44; se ha se&#241;alado una gran disminuci&#243;n de su incidencia en los &#250;ltimos a&#241;os&#46; Este descenso se ha conseguido&#44; en gran parte&#44; gracias a las medidas preventivas establecidas&#58; la introducci&#243;n del test de cribado para el VHC en los bancos de sangre&#44; la extensi&#243;n entre los drogadictos de los programas de intercambio de jeringuillas y la generalizaci&#243;n en el uso de material m&#233;dico desechable en muchos pa&#237;ses&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Es necesario un alto &#237;ndice de sospecha cl&#237;nica y un seguimiento serol&#243;gico y virol&#243;gico estrecho para detectar nuevos casos de HAC<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; En un elevado porcentaje de casos&#44; se diagnostica en el contexto de la vigilancia post-exposici&#243;n y en grupos de riesgo<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;9</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se repasan a continuaci&#243;n las diferentes v&#237;as de trasmisi&#243;n del VHC&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La transmisi&#243;n por v&#237;a parenteral&#44; y en particular el consumo de drogas endovenosas&#44; ha representado la principal causa de contagio para el VHC en los pa&#237;ses desarrollados<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; Recientemente&#44; sin embargo&#44; se ha descrito un creciente n&#250;mero de HAC en varones homosexuales infectados por el virus de la inmunodeficiencia humana &#40;VIH&#41;&#44; lo que sugiere que la epidemiolog&#237;a de la transmisi&#243;n del VHC est&#225; cambiando<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;11&#8211;16</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La transmisi&#243;n por transfusi&#243;n de sangre casi ha desaparecido en los pa&#237;ses desarrollados tras la instauraci&#243;n del despistaje en los bancos de sangre con la aplicaci&#243;n de la PCR &#40;reacci&#243;n en cadena de la polimerasa&#41; autom&#225;tica para el ARN &#40;&#225;cido ribonucleico&#41; de VHC en los donantes<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La transmisi&#243;n por el consumo de drogas sigue siendo el modo predominante &#40;38&#37;&#41; de infecci&#243;n en algunas &#225;reas&#44; sobre todo en los pa&#237;ses de Europa oriental<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#59; pero es pr&#225;cticamente inexistente en los pa&#237;ses occidentales dado el descenso del consumo de drogas por v&#237;a endovenosa&#44; la implantaci&#243;n de los programas de intercambio de jeringuillas y de mantenimiento con metadona&#46; En el colectivo de usuarios de drogas por v&#237;a endovenosa&#44; debemos tener presente que la reinfecci&#243;n no es infrecuente<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La transmisi&#243;n nosocomial representa entre el 15-25&#37; de los casos<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;21</span></a>&#46; Este modo de contagio habitualmente acontece en forma de peque&#241;a epidemia<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;22</span></a> y&#44; en la mayor&#237;a de casos&#44; es debida a una falta en el cumplimiento de las normas est&#225;ndar de higiene<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; Los factores de riesgo relacionados con mayor frecuencia al contagio nosocomial son la cirug&#237;a y los procedimientos diagn&#243;sticos invasivos<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;21</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La transmisi&#243;n ocupacional&#44; el contagio por exposici&#243;n a sangre&#44; representar&#237;a entre un 10-20&#37; de los casos de HAC seg&#250;n se muestran en algunas cohortes retrospectivas<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a>&#46; Los resultados de estudios recientemente publicados muestran un menor riesgo de transmisi&#243;n tras el pinchazo accidental &#40;0&#44;3-2&#44;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La transmisi&#243;n vertical es poco eficaz y representa el 5&#37; de los casos<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46; La infecci&#243;n no se transmite por lactancia materna<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; La hepatitis C vertical cursa de forma asintom&#225;tica en la mayor&#237;a de casos&#46; El 20&#37; de los ni&#241;os negativizan el ARN del VHC en los tres primeros a&#241;os de vida<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El riesgo de transmisi&#243;n sexual en parejas serodiscordantes heterosexuales se considera muy bajo&#44; &#60; 1&#37;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#8211;32</span></a>&#59; y por tanto&#44; no se recomiendan m&#233;todos de barrera preventivos en estos casos&#46; En los pacientes coinfectados por el VIH&#44; parece que el riego de transmisi&#243;n sexual es mayor<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46; En los &#250;ltimos 10 a&#241;os&#44; un creciente n&#250;mero de casos de HAC se han notificado en grandes centros urbanos en Europa<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;11&#44;12</span></a>&#44; los Estados Unidos<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14&#44;34</span></a> y Australia<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; Estudios de cohortes longitudinales han confirmado un aumento en la incidencia del VHC entre pacientes homosexuales VIH-positivos en Inglaterra<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> y los Pa&#237;ses Bajos<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#46; Un estudio internacional reciente ha demostrado&#44; tras realizar un an&#225;lisis filogen&#233;tico&#44; un alto grado de relaci&#243;n de las muestras del VHC de diferentes pa&#237;ses&#44; lo que sugiere una propagaci&#243;n de la hepatitis C a trav&#233;s de una red sexual internacional<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El aumento de la incidencia de HAC en el colectivo homosexual VIH seropositivo se ha atribuido a diferentes factores&#58; una mayor carga viral del VHC en los pacientes coinfectados por el VIH a nivel de sangre y semen<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#8211;40</span></a>&#44; determinadas pr&#225;cticas sexuales en las que existe un riesgo mayor de da&#241;o de la mucosa&#44; la presencia de otras ETS ulcerativas como el linfogranuloma ven&#233;reo o la s&#237;filis de forma concomitante<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&#44; un mayor n&#250;mero de parejas sexuales<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> y el uso de drogas recreativas como la gamma hidroxibutirato &#40;GHB&#41;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Se ha propuesto que la coinfecci&#243;n por el VIH podr&#237;a facilitar la transmisi&#243;n del VHC&#46; Por un lado&#44; aumentar&#237;a la infectividad viral al presentarse con una mayor carga viral del VHC en el suero y semen y por otro lado&#44; estar&#237;a incrementada la susceptibilidad viral debido a un control inmunol&#243;gico deficiente del VHC<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43&#44;44</span></a>&#46; No obstante&#44; existen datos contradictorios en este campo&#44; ya que es frecuente el diagn&#243;stico de la infecci&#243;n aguda por el VHC en pacientes con recuentos de CD4 relativamente preservados o bien realizar un diagn&#243;stico concomitante de primoinfecci&#243;n VIH y de HAC&#46; Parece pues que las conductas sexuales tendr&#237;an un papel m&#225;s importante que el propio VIH como factor de riesgo en la presentaci&#243;n de HAC en estos pacientes<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Cl&#237;nica</span><p id="par0085" class="elsevierStylePara elsevierViewall">La hepatitis aguda ocurre despu&#233;s de un per&#237;odo de incubaci&#243;n variable de 15 a 160 d&#237;as &#40;media de 7 semanas&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">S&#243;lo el 20-30&#37; de todos los pacientes que contrae una hepatitis aguda por el VHC presentar&#225;n cl&#237;nica&#46; Los s&#237;ntomas prodr&#243;micos son sist&#233;micos y variables&#46; La aparici&#243;n de la ictericia puede estar precedida por 1 o 2 semanas de anorexia&#44; n&#225;useas y v&#243;mitos&#44; astenia&#44; artralgias&#44; mialgias&#44; dolor de cabeza&#44; fotofobia y faringitis&#44; as&#237; como alteraciones del gusto y olfato&#46; Se puede apreciar coluria e hipocolia de uno a cinco d&#237;as antes de la aparici&#243;n de la ictericia cl&#237;nica&#46; El h&#237;gado aumenta de tama&#241;o y puede haber dolor en hipocondrio derecho&#46; Un 10-20&#37; de los pacientes tienen esplenomegalia y adenopat&#237;as cervicales&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La fase de recuperaci&#243;n&#44; fase post-ict&#233;rica&#44; se prolonga de 2 a 12 semanas&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La presentaci&#243;n cl&#237;nica de la HAC en el paciente VIH seropositivo es muy similar a la de la poblaci&#243;n monoinfectada&#46; Algunos autores sugieren que podr&#237;a manifestarse con menos signos o s&#237;ntomas cl&#237;nicos de hepatitis y con elevaciones m&#225;s discretas de la ALT s&#233;rica en comparaci&#243;n con los pacientes no infectados por el VIH<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a>&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Evoluci&#243;n</span><p id="par0105" class="elsevierStylePara elsevierViewall">La HAC evoluciona a infecci&#243;n cr&#243;nica hasta en el 85&#37; de los casos&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La eliminaci&#243;n espont&#225;nea se produce en el 23-44&#37; de los pacientes&#44; seg&#250;n el estudio analizado<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">47&#44;48&#8211;51</span></a>&#44; y suele ocurrir dentro de las 12 semanas despu&#233;s del diagn&#243;stico&#59; no obstante&#44; se han descrito casos aislados de seroconversi&#243;n tard&#237;a&#44; hasta 12 meses<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">48&#44;51</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En general&#44; los pacientes con enfermedad sintom&#225;tica&#44; ictericia o s&#237;ntomas pseudogripales&#44; parecen experimentar una mayor eliminaci&#243;n viral espont&#225;nea<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">47&#8211;50&#44;52</span></a>&#46; Tambi&#233;n se ha observado un porcentaje muy elevado de curaci&#243;n espont&#225;nea en los pacientes que presentan una disminuci&#243;n r&#225;pida de la carga viral<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">53&#44;54</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Varios trabajos han demostrado que una respuesta inmune celular fuerte y multiespec&#237;fica ser&#237;a un factor importante para la erradicaci&#243;n viral espont&#225;nea<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">55&#8211;57</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Existe en la actualidad gran inter&#233;s en los estudios gen&#233;ticos&#59; se ha descrito que la presencia de un polimorfismo en el gen que codifica para la interleukina &#40;IL28B&#41; en el cromosoma 19 predice la eliminaci&#243;n viral espont&#225;nea<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a>&#44; as&#237; como un mayor porcentaje de respuesta viral al tratamiento anti-VHC en el paciente monoinfectado<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a>&#46; En el paciente coinfectado por el VIH&#44; este polimorfismo tambi&#233;n se ha relacionado con la RVS al tratamiento<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">60&#44;61</span></a>&#44; pero no con una mayor eliminaci&#243;n viral espont&#225;nea en la HAC<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">61</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Estudios recientes sobre el diagn&#243;stico y el curso natural de la infecci&#243;n aguda por el VHC en personas VIH-positivas han reportado porcentajes de eliminaci&#243;n espont&#225;nea de entre 13 y 16&#37;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">62&#44;63</span></a>&#44; valores menores en comparaci&#243;n con los individuos mono-infectados&#46; Desafortunadamente no existen datos sobre el tiempo necesario de espera para valorar la eliminaci&#243;n viral espont&#225;nea en el paciente coinfectado&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Debemos tener en cuenta que los pacientes VIH con HAC&#44; tienen mayor riesgo de progresi&#243;n de la enfermedad hep&#225;tica relacionada<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a> y menor respuesta a la terapia antiviral para el VHC&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Diagn&#243;stico</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Datos de laboratorio</span><p id="par0140" class="elsevierStylePara elsevierViewall">La elevaci&#243;n de aminotransferasas se inicia en la fase prodr&#243;mica de la hepatitis antes del aumento de bilirrubina&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Se puede observar de forma transitoria&#44; neutropenia y linfopenia&#44; seguidas de linfocitosis relativa&#46; Son frecuentes los linfocitos at&#237;picos durante la fase aguda&#46; Tambi&#233;n durante esta fase&#44; se pueden detectar anticuerpos anti m&#250;sculo liso&#44; antinucleares y otros componentes celulares&#44; factor reumatoide y anticuerpos heter&#243;filos a t&#237;tulo bajo&#46; Es com&#250;n una ligera elevaci&#243;n de gammaglobulinas&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de la infecci&#243;n aguda por el VHC se basa en la detecci&#243;n de ARN del VHC por PCR junto a documentaci&#243;n de la existencia de una seroconversi&#243;n de los anticuerpos del VHC &#40;anti VHC&#41;&#46; En aquellos casos que la seroconversi&#243;n anti VHC no se puede probar&#44; existen unos criterios adicionales que pueden apoyar el diagn&#243;stico de sospecha&#58; los niveles de ALT &#62; 10-20 veces el l&#237;mite superior de lo normal&#44; la sospecha de un contacto de riesgo con el VHC los 6 meses previo y haberse descartado cualquier otra causa de da&#241;o hep&#225;tico &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">El <span class="elsevierStyleItalic">screening</span> serol&#243;gico de anti VHC no es fiable durante la infecci&#243;n temprana&#44; ya que estos anticuerpos pueden tardar hasta 12 semanas tras la exposici&#243;n en detectarse&#46; Asimismo pueden existir falsos anti VHC positivos en pacientes con factor reumatoide&#46; En estos casos&#44; es posible realizar un ensayo de inmunoblot recombinante &#40;RIBA&#41; de confirmaci&#243;n&#44; para establecer las prote&#237;nas espec&#237;ficas a las que se dirige el anti VHC&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">La determinaci&#243;n de ARN de VHC por PCR es el m&#233;todo m&#225;s sensible para el diagn&#243;stico de infecci&#243;n por VHC y aparece antes de los anti VHC y de la elevaci&#243;n de transaminasas&#59; hasta en un 30&#37; de los pacientes el an&#225;lisis de ARN del VHC por PCR ser&#225; la &#250;nica posibilidad de diagnosticar la infecci&#243;n aguda por el VHC<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Tratamiento</span><p id="par0165" class="elsevierStylePara elsevierViewall">No es necesario el reposo en cama para la recuperaci&#243;n&#44; pero algunos pacientes con astenia importante se encuentran mejor restringiendo su actividad f&#237;sica&#46; Es aconsejable una dieta elevada en calor&#237;as y no muy grasa para evitar la sensaci&#243;n de plenitud&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">El ingreso para administraci&#243;n de l&#237;quidos intravenosos puede estar indicado si existe un cuadro de v&#243;mitos importante&#46; Se debe evitar medicaci&#243;n metabolizada en el h&#237;gado y hepatot&#243;xica&#46; Si es muy llamativo el prurito&#44; se puede utilizar resincolestiramina&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A diferencia de la hepatitis C cr&#243;nica&#44; no ha sido establecida hasta el momento cual debe ser la pauta de terapia antiviral est&#225;ndar en la fase aguda de la enfermedad y muchos aspectos importantes del tratamiento est&#225;n actualmente bajo investigaci&#243;n&#46; Los ensayos cl&#237;nicos centrados en el tratamiento de la HAC se ven obstaculizados por las dificultades en su diagn&#243;stico&#46; As&#237;&#44; la mayor&#237;a de los estudios que existen son abiertos&#44; no comparativos e incluyen pocos pacientes&#46; C&#243;mo difieren ampliamente entre ellos en cuanto a dise&#241;o&#44; poblaci&#243;n de pacientes y los reg&#237;menes de tratamiento&#44; no es posible discernir de forma rotunda cual es la intervenci&#243;n m&#225;s eficaz&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Los datos obtenidos hasta la fecha en diferentes estudios realizados en pacientes monoinfectados muestran que tanto el interfer&#243;n convencional como el pegilado son &#250;tiles en el tratamiento de la HAC y que la terapia combinada con ribavirina no mejora los resultados<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">52&#44;61&#44;66-69</span></a>&#46; Adem&#225;s se ha valorado que el porcentaje de respuesta viral sostenida &#40;RVS&#41; a la terapia en la HAC es independiente del genotipo del VHC&#46; En cuanto a la duraci&#243;n &#243;ptima del tratamiento se establece en 24 semanas&#46; Peque&#241;os estudios con pocos pacientes han analizado la posibilidad de reducir el tratamiento a 12 semanas pero&#44; hasta el momento&#44; los resultados obtenidos son insuficientes para poder establecer una gu&#237;a<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">67&#44;70</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">El tratamiento se debe iniciar entre la 8<span class="elsevierStyleSup">a</span> y 12<span class="elsevierStyleSup">a</span> semanas tras el diagn&#243;stico&#44; si no se ha resuelto espont&#225;neamente la infecci&#243;n&#46; Empezar el tratamiento inmediatamente tras el diagn&#243;stico del paciente&#44; puede significar que algunos pacientes que podr&#237;an aclarar de forma espont&#225;nea el virus sean expuestos a la terapia antiviral sin necesidad de ella&#59; pero retrasarlo disminuir&#237;a su eficacia&#46; La terapia generalmente es bien tolerada y se alcanza una RVS del 71-98&#37; en los ensayos en pacientes monoinfectados tratados durante 24 semanas &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los datos disponibles de respuesta al tratamiento de la HAC en individuos infectados por el VIH son estudios realizados con pautas de 24 semanas de duraci&#243;n con terapia combinada con interfer&#243;n pegilado m&#225;s ribavirina&#46; Estos estudios muestran un porcentaje muy variable de RVS del 0-80&#37;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13&#44;15&#44;33&#44;71&#8211;76</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#44; y menor a la observada en los individuos monoinfectados con HAC&#46; Teniendo en cuenta el curso cl&#237;nico de la HAC&#44; la <span class="elsevierStyleItalic">European AIDS Clinical Society</span> &#40;EACS&#41;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">77</span></a> recomienda la intervenci&#243;n terap&#233;utica temprana a partir de la semana 12 y evitar cualquier demora de tratamiento posterior que podr&#237;a dar lugar a una disminuci&#243;n de la respuesta al tratamiento&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0195" class="elsevierStylePara elsevierViewall">La discusi&#243;n actual de la individualizaci&#243;n del tratamiento en la hepatitis cr&#243;nica C tambi&#233;n influye en el debate de la HAC&#46; Se han descrito varios factores predictivos de RVS en la literatura&#58; la ictericia<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#44;48</span></a>&#44; la importancia de la respuesta inmunol&#243;gica<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">78</span></a>&#44; la transmisi&#243;n nosocomial&#44; una carga viral baja&#44; la edad menor de 30 a&#241;os y la r&#225;pida reducci&#243;n de la carga viral en las primera semanas<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;49&#44;50&#44;72</span></a>&#46; En el paciente coinfectado&#44; el presentar niveles altos basales de ALT as&#237; como un recuento elevado de CD4<span class="elsevierStyleSup">71</span> y la negativizaci&#243;n de ARN del VHC de forma precoz<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;72</span></a> son los factores que se ha relacionado con la RVS&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Profilaxis</span><p id="par0200" class="elsevierStylePara elsevierViewall">La respuesta inmunitaria humoral que se produce ante el VHC no es efectiva&#46; Los anticuerpos anti VHC no son bloqueantes del virus&#59; de esta forma&#44; el contagio por el VHC no produce inmunidad permanente frente a la reinfecci&#243;n por el mismo u otro genotipo de VHC&#46; As&#237; se han descrito casos de superinfecci&#243;n y reinfecci&#243;n por el VHC<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">El desarrollo de vacunas est&#225; limitado por la heterogeneidad del virus &#40;genotipos&#44; cuasiespecies&#41; y la f&#225;cil evasi&#243;n del virus a anticuerpos neutralizantes por su rapidez para mutar&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Es necesario destinar recursos para promover campa&#241;as educativas dirigidas a pacientes y m&#233;dicos&#44; insistir en la prevenci&#243;n espec&#237;fica en los grupos de riesgo&#44; mejorar la detecci&#243;n y facilitar el tratamiento del VHC&#46; La detecci&#243;n de anti VHC debe ser parte de la atenci&#243;n habitual de todos los pacientes homosexuales VIH y debemos tener un alto grado de alerta cl&#237;nico ante la posibilidad de una infecci&#243;n concomitante por VHC para cualquier paciente que se presente con una enfermedad de transmisi&#243;n sexual o que informe de haber presentado una exposici&#243;n de alto riesgo&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0215" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaRecibido" => "2010-08-04"
    "fechaAceptado" => "2010-12-16"
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        "titulo" => "Resumen"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La hepatitis aguda C &#40;HAC&#41; representa un problema sanitario en auge&#46; A pesar del descenso de la transmisi&#243;n del VHC por v&#237;a hematol&#243;gica gracias a los programas de detecci&#243;n de donantes y el menor consumo de drogas por v&#237;a intravenosa&#44; actualmente existe un aumento de su incidencia debido al contagio por v&#237;a sexual&#44; sobretodo en pacientes homosexuales infectados por el VIH&#46; La presentaci&#243;n de forma paucisintom&#225;tica es frecuente&#44; lo cual dificulta su diagn&#243;stico&#46; La eliminaci&#243;n espont&#225;nea del virus ocurre en el 25&#37; de los casos y&#44; habitualmente&#44; durante los primeros tres meses tras el inicio de la cl&#237;nica y en pacientes sintom&#225;ticos&#46; Si el ARN del VHC persiste detectable pasado este tiempo debe iniciarse sin demora tratamiento antiviral&#44; ya que en la fase aguda el porcentaje de respuesta viral sostenida es mayor al que se obtiene despu&#233;s en la hepatopat&#237;a cr&#243;nica&#46; La pauta de tratamiento &#243;ptima &#40;interfer&#243;n s&#243;lo o asociado a ribavirina&#41;&#44; as&#237; como la duraci&#243;n de la misma no est&#225;n claramente establecidas en el momento actual&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Acute hepatitis C &#40;AHC&#41; is an increasing health issue&#46; Despite the decline of blood-to-blood transmission of hepatitis C virus &#40;HCV&#41; through donor screening programs and a decline in intravenous drug use&#44; the incidence of sexual transmission has now increased&#44; particularly in HIV-infected homosexual patients&#46; The presentation is almost always asymptomatic&#44; which complicates diagnosis&#46; Spontaneous clearance of the virus occurs in 25&#37; of cases and usually&#44; within the first three months after onset of symptoms and in symptomatic patients&#46; If serum HCV-RNA remains detectable after this period&#44; antiviral treatment should be started without delay&#44; since sustained viral response rate in the acute phase is higher than that achieved with chronic liver disease&#46; The optimal treatment regimen &#40;interferon alone or combined with ribavirin&#41; and its duration are not clearly established at the present time&#46;</p>"
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Evoluci&#243;n cl&#237;nica y anal&#237;tica de la infecci&#243;n por el VHC&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ALT&#58; alaninaminotransferasa&#59; ARN del VHC&#58; &#225;cido ribonucleico del virus de la hepatitis C&#59; antiVHC&#58; anticuerpos contra el VHC&#46;</p>"
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                  \t\t\t\t">Criterios mayores</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Detecci&#243;n de ARN del VHC en suero en un paciente con un VHC negativo previamente&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Seroconversi&#243;n de antiVHC negativo a antiVHC positivo&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Criterios secundarios</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Niveles de ALT &#62; 10-20 veces el l&#237;mite superior de lo normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de un contacto de riesgo con el VHC los 6 meses previos&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Se haya descartado cualquier otra causa de da&#241;o hep&#225;tico&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Consideraciones adicionales</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aparici&#243;n repentina de enfermedad hep&#225;tica&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Repetici&#243;n de pruebas RIBA &#40;ensayo de inmunoblot recombinante&#41; que demuestren un aumento en el n&#250;mero de prote&#237;nas reactivas&#46;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">ADVP&#58; adicci&#243;n a drogas por v&#237;a parenteral&#59; INF alfa&#58; interfer&#243;n alfa&#59; pac&#58; pacientes&#59; PEG INF&#58; interfer&#243;n pegilado&#59; RBV&#58; ribavirina&#59; sem&#58; semanas&#59; RVS&#58; respuesta viral sostenida&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Estudio Origen&#44; &#40;cita&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Pacientes tratados &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Datos demogr&#225;ficos y cl&#237;nicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">RVS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Eliminaci&#243;n espont&#225;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alemania<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37; ADVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Interfer&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#37; genotipo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alemania&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#37; ADVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">INF alfa &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10 pac&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RBV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10 pac&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#37; asintom&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2 pac&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RBV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4 pac&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14-61 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jap&#243;n<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">80</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#37; ADVP</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">INF alfa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; inicio 8 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inicio a 8 vs 52 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#37; inicio 52 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inglaterra<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">81</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#37; ADVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">INF alfa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#37; asintom&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#37; genotipo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alemania<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">82</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No ADVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#37; asintom&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#37; genotipo 1&#47;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suiza<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">83</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#37; ADVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#37; asintom&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Italia<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">84</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37; ADVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37; asintom&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#37; genotipo 1&#47;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Italia<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#37; asintom&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#37; genotipo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Egipto&#44; Alemania y EE&#46;UU&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#37; ADVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#37; 8 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#37; genotipo 1&#47;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 sem &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#37; 12 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 sem &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#37; 24 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 sem &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Italia<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; ADVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#37; genotipo 1&#47;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Italia<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">86</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#37; ADVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#37; asintom&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#37; genotipo 1&#47;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">HMX&#58; var&#243;n homosexual&#59; INF alfa&#58; interfer&#243;n alfa&#59; pac&#58; pacientes&#59; PEG INF&#58; interfer&#243;n pegilado&#59; RBV&#58; ribavirina&#59; sem&#58; semanas&#59; RVS&#58; respuesta viral sostenida&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Estudio origen&#44; &#40;cita&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Pacientes tratados &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Datos demogr&#225;ficos y cl&#237;nicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">RVS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Eliminaci&#243;n espont&#225;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Londres<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">71</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; HMX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RBV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#37; genotipo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paris<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; HMX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RBV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#37; asintom&#225;ticos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#37; genotipo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">California<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#37; HMX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RBV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24-48sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paris<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; HMX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">INF alfa &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#37; asintom&#225;ticos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">INF alfa<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RBV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; y PEG INF &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#37; genotipo 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24-48 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alemania<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">73</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; HMX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#37; genotipo 1&#47;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RBV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24-48 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nueva York<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#37; HMX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RBV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#37; genotipo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24-48 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Australia<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#37; HMX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RBV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#37; &#40;16&#47;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#37; asintom&#225;ticos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#37; &#40;16&#47;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#37; genotipo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Holanda<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">74</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; HMX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RBV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#37; genotipo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37; genotipo 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24-48 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">75</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#37; HMX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RBV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#37; genotipo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 sem&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alemania<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">76</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; HMX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PEG INF &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RBV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#37; genotipo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 sem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#37; genotipo 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Tratamiento de la hepatitis aguda C en pacientes coinfectados por el VIH&#46;</p>"
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          "identificador" => "bibs0005"
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                    0 => array:2 [
                      "titulo" => "Hepatitis C en Espa&#241;a"
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                        0 => array:2 [
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                            0 => "M&#46; Bruguera"
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                      "Revista" => array:4 [
                        "tituloSerie" => "Med Clin&#46;"
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                      "titulo" => "Prevention of hepatitis C in Italy&#58; lessons from surveillance of type-specific acute viral hepatitis&#46; SEIEVA collaborating Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Mele"
                            1 => "M&#46;E&#46; Tosti"
                            2 => "A&#46; Marzolini"
                            3 => "A&#46; Moiraghi"
                            4 => "P&#46; Ragni"
                            5 => "G&#46; Gallo"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Viral Hepat&#46;"
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                        "volumen" => "7"
                        "paginaInicial" => "30"
                        "paginaFinal" => "35"
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  "PDF" => "https://static.elsevier.es/multimedia/0213005X/0000002900000003/v1_201305090245/S0213005X10004982/v1_201305090245/es/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X10004982?idApp=UINPBA00004N"
]

Información del artículo

ISSN: 0213005X
Idioma original: Español

DOI:10.1016/j.eimc.2010.12.005

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2023 Octubre	110	20	130
2023 Septiembre	63	9	72
2023 Agosto	80	8	88
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2023 Junio	79	20	99
2023 Mayo	138	4	142
2023 Abril	100	8	108
2023 Marzo	71	14	85
2023 Febrero	64	19	83
2023 Enero	92	15	107
2022 Diciembre	70	22	92
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2022 Octubre	76	14	90
2022 Septiembre	59	38	97
2022 Agosto	69	28	97
2022 Julio	57	16	73
2022 Junio	47	16	63
2022 Mayo	63	35	98
2022 Abril	53	20	73
2022 Marzo	68	40	108
2022 Febrero	71	29	100
2022 Enero	82	41	123
2021 Diciembre	78	29	107
2021 Noviembre	75	39	114
2021 Octubre	109	19	128
2021 Septiembre	71	32	103
2021 Agosto	64	22	86
2021 Julio	54	22	76
2021 Junio	53	27	80
2021 Mayo	85	28	113
2021 Abril	165	15	180
2021 Marzo	82	18	100
2021 Febrero	74	12	86
2021 Enero	83	14	97
2020 Diciembre	48	11	59
2020 Noviembre	73	17	90
2020 Octubre	53	6	59
2020 Septiembre	54	17	71
2020 Agosto	60	14	74
2020 Julio	33	8	41
2020 Junio	51	18	69
2020 Mayo	57	22	79
2020 Abril	64	16	80
2020 Marzo	84	17	101
2020 Febrero	66	19	85
2020 Enero	59	18	77
2019 Diciembre	40	39	79
2019 Noviembre	68	24	92
2019 Octubre	77	33	110
2019 Septiembre	72	15	87
2019 Agosto	79	16	95
2019 Julio	70	24	94
2019 Junio	112	51	163
2019 Mayo	111	140	251
2019 Abril	148	46	194
2019 Marzo	123	37	160
2019 Febrero	85	25	110
2019 Enero	100	10	110
2018 Diciembre	91	17	108
2018 Noviembre	131	45	176
2018 Octubre	126	37	163
2018 Septiembre	197	22	219
2018 Agosto	110	20	130
2018 Julio	54	14	68
2018 Junio	74	16	90
2018 Mayo	83	14	97
2018 Abril	76	10	86
2018 Marzo	66	17	83
2018 Febrero	110	4	114
2018 Enero	48	5	53
2017 Diciembre	45	4	49
2017 Noviembre	73	7	80
2017 Octubre	62	7	69
2017 Septiembre	50	14	64
2017 Agosto	60	17	77
2017 Julio	49	7	56
2017 Junio	72	22	94
2017 Mayo	120	13	133
2017 Abril	100	23	123
2017 Marzo	109	14	123
2017 Febrero	406	15	421
2017 Enero	142	8	150
2016 Diciembre	134	8	142
2016 Noviembre	203	10	213
2016 Octubre	218	23	241
2016 Septiembre	176	26	202
2016 Agosto	183	22	205
2016 Julio	130	15	145
2016 Junio	148	30	178
2016 Mayo	132	35	167
2016 Abril	148	29	177
2016 Marzo	125	26	151
2016 Febrero	114	23	137
2016 Enero	129	26	155
2015 Diciembre	99	22	121
2015 Noviembre	156	32	188
2015 Octubre	178	34	212
2015 Septiembre	134	29	163
2015 Agosto	109	24	133
2015 Julio	102	9	111
2015 Junio	105	25	130
2015 Mayo	116	16	132
2015 Abril	106	24	130
2015 Marzo	135	14	149
2015 Febrero	77	9	86
2015 Enero	79	10	89
2014 Diciembre	120	13	133
2014 Noviembre	112	12	124
2014 Octubre	116	8	124
2014 Septiembre	138	10	148
2014 Agosto	114	7	121
2014 Julio	147	9	156
2014 Junio	132	10	142
2014 Mayo	97	6	103
2014 Abril	81	5	86
2014 Marzo	128	8	136
2014 Febrero	137	6	143
2014 Enero	100	7	107
2013 Diciembre	118	7	125
2013 Noviembre	141	12	153
2013 Octubre	142	9	151
2013 Septiembre	67	19	86
2013 Agosto	85	25	110
2013 Julio	71	9	80
2013 Junio	10	0	10
2013 Mayo	19	0	19
2013 Abril	7	0	7
2013 Marzo	3	0	3
2013 Febrero	3	0	3
2013 Enero	3	0	3
2012 Diciembre	4	0	4
2012 Octubre	3	0	3
2011 Marzo	2053	0	2053

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